Dental groups urge Nebraska Medicaid office to halt pediatric dental audits

Clinical Leadership & Infection Control

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Four Nebraska dental organizations are concerned Medicaid pediatric dental audits in the state are inhibiting children's access to oral care, the organizations wrote in a Nov. 6 letter to the state's Medicaid agency, according to the American Dental Association. 

The American Academy of Pediatric Dentistry, American Dental Association, Nebraska Society of Pediatric Dentistry and Nebraska Dental Association voiced concern over audits of several Nebraska pediatric dentists in 2018 by AdvanceMed, which is contracted under CMS. The organizations said they believe dental auditors were not basing reviews on AAPD's clinical recommendations, citing a November 2018 correspondence from AdvanceMed that stated AAPD's clinical recommendations were irrelevant to audit findings.

The organizations were also troubled that different audits questioned the use of stainless steel crowns in children with high caries risk and requested refunds for alleged inappropriate treatment. The dental groups believe the auditor only considered the financial benefits and ignored the caries risk assessment.

The groups said the CMS Guide to Children's Care in Medicaid indicates that children who are at high risk for caries "may require more frequent diagnostic and preventive procedures."

The letter noted a specific pediatric dentist who, after incurring significant legal fees in an appeal of a Medicaid agency audit, gave up the appeal and stopped being a Medicaid provider.

The dental organizations detailed similar audits of pediatric dentists in Nebraska and stressed that "misguided audits like these only hurt children’s access to dental care," endanger the viability of Medicaid provider networks, and put the state’s dental educators in a difficult position since they teach the AAPD clinical recommendations.

The dental groups asked the Nebraska Division of Medicaid and Long-Term Care to halt the audits and require all future auditors to use dental profession clinical guidelines and best practices of the appropriate specialty organization, such as the AAPD. They asked for contracted auditors to use licensed dentists of equivalent education and training as the dentists being audited and to have experience treating Medicaid patients.

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